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Post by Mark J on Apr 16, 2022 11:23:10 GMT -7
[Original subject line:Conservative Stage 4/3 IVDD ] i.postimg.cc/6pKdJGNJ/Bichon.jpg i.postimg.cc/J43ZF2Nx/Conserv-NECK.pngI have writing about my 11-year old male Bichon who had an IVDD episode above his shoulders the morning of April 12 and was initially diagnosed at stage 4. Since our city and region lacks Ultrasound / CT Scan capabilities, the doctor reached out for referrals to hospitals several hours away, and prescribed crate rest and the following meds in the interim: Methocarbamol 200 mg - 0.6 ml(liquid by mouth) every 8 hours for 7 days Gabapentin 50mg tabs - 1 - 1.5 tabs every 8 hours Prednisone 5 mg tabs - 1 tab / 12 hours for 5 days; 1 tab / 24 hours 5 days; 1 tab /48 hours 5 days [MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 11 y.o.
prednisone as of 4/12: 5mgs 2x/day for 5 days, then 4/17 test taper for: _pain / _neuro
gabapentin 50 mgs tab: 75mg 3x/day
methocarbamol 200mgs/1 mL: 120mg (0.6mL dose) 3x/day
Dog needs GI tract protector, Pepcid AC, on board w/prednisone!]
Initially, he had deep pain and minor mobility in his back legs but none in the front, with urinary and defecatory retention. By April 13, he ate but didn't drink, could move his back legs but not his front legs, and needed cathaterization for urnine. By April 14, he ate and drank, could move his back legs and front legs and had defecatory function (five poops!) but still needed catheterization for urine. By April 15, he r egained urinary function [proof signs?] but incontinent (wets his bed). By today, April 16, he started lying in his normal, spine-up and straight or curled positions rather than flat on his side, but he seems extremely tired / lethargic, is sleeping more than he ever has since the initial episode. He peed his crate this morning but is refusing water (he took a few laps first thing this morning, but that's it). I am getting a little worried since my vet is away for Easter weekend and I have no way of knowing whether he is still improving or whether his lethargy is a bad sign. Is the sleep a good thing or not? Is he simply pooped, or could it be a sign of something else? Should he still be catheterized in case he isn't emptying his bladder completely? Could someone who has walked this path offer any wisdom or reassurance? Am I unwise to continue this conservative path at this point? Is his progress thus far typical or not? Might he plateau at this stage or regress? I would really appreciate some guidance / advice.
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Post by Mark J on Apr 16, 2022 11:55:59 GMT -7
Gabapentin 50 mg.
Methacarbamol00 mg/ml.
Am giving Prednisone in cheese.
No longer retaining urine altogether (but not sure he's voiding completel either).
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PaulaM
Moderator. 
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 16, 2022 12:00:21 GMT -7
Mark welcome to the Forum! First thing is that your dog (what's the name?) IS, indeed going on a very good forward path of healing his front leg and back leg neuro function. Here are the things to concentrate on 🍫1) asap Stomach protection. You are likely seeing a red flag sign of not wanting to drink. Get GI tract protector, Pepcid AC, on board for the duration of Prednisone TODAY, ASAP. ! Dogs don't speak up at first signs of trouble like a person would. Red flag signs can progress from nausea> not drinking/eating> vomit> loose stool>.... Bleeding ulcers (red or black blood in diarrhea) can turn to a life-threatening perforated stomach lining. LEARN MORE: dodgerslist.com/2020/05/06/stomach-protection/
FIRST chance vet is open: do confirm Pepcid with your vet in this very, very particular way... -- Is there a medical/health reason my dog may not take Pepcid AC (famotidine)? -- Doesn’t need it, we wait til there is problem…are NOT answers to your question! -- The dose of famotidine may require reduction in patients with liver or kidney disease. -- It may be prudent with heart patients to choose another class of acid reducer.
The usual dose of Pepcid AC (famotidine) for dogs is 0.44mg per pound.
--Give 30 mins before the anti-inflammatory. --Dose thereafter every 12 hours for as long as your dog is on the anti-inflammatory. thumb.ibb.co/mEGRuy/91x_Aj_s00z_L_SY355.jpg ** MED info missing
dog's weight?Gabapentin WHICH?: 50 or 75mgs 3x/day methocarbamol formula: ?mgs/mL: ?mg (0.6mL dose) 3x/day Proof of bladder control
Let us know if he passes the SNIFF and PEE test.The only way for humans to know if there is bladder control is with the “sniff and pee test.”
Carry outdoors, set them on an old pee spot to sniff. Make sure the sling or your hands are not on the tummy area as that can press on the bladder. See if they will release urine on the old urine area.
If urine comes out after sniffing, bladder control is returning.
You should continue to do a quick express check to verify there is full voiding until you are certain it is consistently happening. Let us know what you observe. Learning to express after a vet lesson: dodgerslist.com/2020/05/05/bladder-bowel-care/
Catheters are a last resort thing mostly. Most vets teach how to express. You can become expert in a matter of a weeks worth of expressing your dog's bladder.
Mark, please register so we can best track your dog and give the best assistance. What to expect during registration: dodgerslist.com/2021/06/30/forum-registration
Registering openS up THE feature to get an email alert when you have a reply. Timely communication is essential for best care of your dog.Will be watching for your next post to learn about the meds if they might be too strong or not for his weight. That you have his GI tract protect with Pepcid AC. And if you have proof your dog is regaining bladder control. |
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Post by Mark J on Apr 16, 2022 12:22:52 GMT -7
Hi Paula,
Thanks so much for your reply! It is such a blessing to find someone who has some knowledge and can offer reassurance. Here is the missing med info:
Methocarbamol 200mg/ml oral susp - 0.6 ml / 8 hrs. for 7 days
Gabapentin 50 mg (Summit) 1.5 tablets / 8-12 hrs.
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Post by Mark J on Apr 16, 2022 12:35:04 GMT -7
And his weight is 15 pounds. Sorry, I forgot to add that. He has NOT yet passed the smell and pee test, though I have had him on the "grand tour" of hot spots each day. He is currently just voiding randomly, it seems, but he was retaining completely until yesterday, which is why the catheterization. Vet said his bladder was refusing expression and she feared rupture, but perhaps now that he is voiding we can try expression again? Thanks for the tip in the Pecid -- I actually noticed dark areas in the stool a few days ago and again yesterday, so together with the water refusal / lethary, that makes sense. Would bismuth subsaliclate work for now?
[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 11 y.o.
prednisone as of 4/12: 5mgs 2x/day for 5 days, then 4/17 test taper for: _pain / _neuro
gabapentin 50 mgs tab: 75mg 3x/day
methocarbamol 200mgs/1 mL: 120mg (0.6mL dose) 3x/day
Dog needs GI tract protector, Pepcid AC, on board w/prednisone!]
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Post by Romy & Frankie on Apr 16, 2022 13:25:29 GMT -7
It is important NOT to give bismuth subsaliclate. It contains subsalicylate which is a derivative of Aspirin,a NSAID which should never be given when on a steroid or other NSAID.
Try to get the Pepcid AC (famotidine) onboard as soon as you can, as he is showing signs of possible stomach damage.
Some dogs are just difficult to express. There are some meds that can help with this. You can discuss this with your vet. Two of these meds are:
Phenoxybenzamine, which also relaxes the urethral sphincter
Continue to give him frequent opportunities to sniff and pee.
We encourage you to register and become a member of the Forum. That way it will be easier for you to reply and make it easier for us to track your dog and give the best of comments and support.
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Post by Mark J on Apr 16, 2022 14:55:17 GMT -7
Ok -- no bismuth. And advocate for Pepcid ASAP. Thanks for that.
Watched the video on bladder expression and tried again, but no luck so far. I think I have located it but the pressure makes him sit up and tense. With his front paws so immobile, I can't express with him sitting up. Still worried about whether I am doing the right thing here -- what are the chances he will walk again following a conservative path with a Stage 4 diagnosis? Are there some testimonials by others that I can read somewhere to give me hope? I don't want to deprive this fellow of the possibility of full mobility. Right now I feel isolated, exhausted, and stressed out with uncertainty and anxiety.
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Post by Romy & Frankie on Apr 16, 2022 15:15:29 GMT -7
Mark, it is very stressful and scary when our dogs have IVDD. It becomes less so when you learn all you can about the disease. Dodgerslist has a large community of people who have/had a dog with IVDD. We know what you are going through because we have been there. You are not alone. A tip from one of our Moderators; A warm towel from the dryer on the stomach can help relax the dog when you are just learning. Tapping gently on the tummy to jiggle the muscles will also help relax a tight tummy. A lttle Valium has helped some dogs on our list.
But most importantly, expressing is a skill and must be learned. I struggled to be able to express my dog. I went back to the vet several times and the vet techs showed me again. I tried different positions. I thought I would never get it, but finally, I was able to do it! I needed to express for months and after a while, it became second nature. My story is not uncommon. I learned and you will also.
You are absolutely doing the right thing. It is very early on in the healing process and there is no way to tell the extent of your dog's recovery. We have success stories here:
Not all these dogs regained the ability to walk, but all went on to live happy lives Your dog can too regardless of the extent of his recovery.
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Post by Mark J on Apr 16, 2022 17:34:33 GMT -7
Thanks for the encouragement. I really needed to read a few success stories to get some perspective / hope. I have read a much as I can find about this disease but there is some conflicting information and statistics so it is difficult to know what to believe.
Had success with him drinking again and showing much more alertness after eating his dinner, so I am feeling calmer now. Will get some Pepcid tomorrow -- his prednisone dosage also decreases tomorrow so hopefully that combination will give him some relief.
p.s., tried registering by requesting activation key twice but no email in my hotmail yet...
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 16, 2022 18:16:50 GMT -7
Mark, can you use a different email address to register? Mark, each dog's disc episode can be different in damage. So it is very hard to compare your dog with another. As Romy said just know in your heart that dogs don't care how they get from point A to point B. Just that they can. Many dogs do recover the ability to walk anywhere from weeks to a year whether after a surgery or with conservative treatment. if your dog still needs more time to work on nerve function, there are wheelchairs until nerve function returns!
Which are you actually giving Gabapentin 75mgs dose every 12 hrs or every 8 hrs?Tomorrow 4/17 is the taper of prednisone. It will no longer be working on swelling. Your job is to assess for pain or wosening neuro function. To expedite your assessment and have the ability to be accurate, vets stop the pain meds at the begin of the taper. Pain meds block pain. The idea is to know if all painful swelling is gone or not. If not gone evidenced by your observing any hint of pain surfacing or neuro function diminishes, then you and your vet know to get Pred back up at the anti-inflammatory dose ASAP, pronto. Hours matter in preserving neuro function. DISCUSS stopping of pain meds or at least backing off them starting 4/17 to get a quick read if another course of pred is needed. A 5-day course of pred is rather short, so do not be upset if another course is needed. Often it will take somewhere under 30 days of an anti-inflammatory to resolve all pain swelling around the cord. HOW to monitor neuro functionNote both back leg and front leg function since this is a neck disc.As damage to the spinal cord increases, there is a predictable stepwise deterioration of functions. When nerve healing begins, often it follows the reverse order. 1. Pain caused by the intial disc tear & inflammation in the spinal cord 2. Wobbly walking, legs cross 3. Nails/toes scuffing floor 4. Paws knuckle under 5. 4/14 Weak/some leg movement w/front/back legs ? can't move up into a stand front: ? ; back: ?6. Legs do not work at all (paralysis, dog is down) 7. ? Bladder control is lost. Leaks on you when lifted. Can no longer sniff and then pee on that old urine spot outdoors. 8. ___ Stump or butt wriggles of joy is lost 9. Deep pain sensation, the last neuro function, a critical indicator for nerves to be able to self heal after surgery or with conservative treatment. If surgery is not an option (for whatever reason) then the best option is conservative therapy. Surgery can still be successful in the window of 12-24 hours after loss of deep pain sensation. Even after that window of time, there can still be a good outcome. Each hour that passes decreases that chance. Precious hours can be lost with a vet that gets DPS wrong. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about DPS. So if surgery is an option for your family get to a neuro or ortho asap. A quick overview of conservative treatment vs. a surgery: dodgerslist.com/2020/02/10/surgery-vs-conservative/ Important to understand how Prednisone is used during a disc episode: dodgerslist.com/2020/04/18/steroids-vs-nsaids/Keep us posted on how things are going with expressing lesson from your vet. And what you observe on the TEST FOR PAIN prednisone taper 4/17. |
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Post by Mark J on Apr 16, 2022 18:59:24 GMT -7
Thanks for all that, Paula.
Have been giving Gabaentin 75 mgs every 8 hours. Will ask vet tomorrow about cutting pain meds and checking or pain / neurological loss.
This guy is very stoic and showed no sign of pain afterward except for a little cry at the point of rupture. Should I advocate for longer prednisone up front? It seems scary to cut it short if we are risking further inflammastion / neurological loss.
Methocarbamol finishes Tuesday -- should I be advocating for a renewed script on that, or not?
During potty time, he likes to "stand" up and use his back legs to push out the poop -- is this allowing too much strain on his spine? Should he be left to poop lying flat on his side instead? He seems really "pooped" after a successful potty time.
5. 4/14 Weak/some leg movement w/front/back legs
Not sure what this means -- can't move up into a stand
front: yes but wobbly ; back: yes (if this means lying spine up and feet below rather than on his side)
Yes -- bladder control not yet observed (incontinent)
8. _NO__ Stump or butt wriggles of joy is lost
Seems from this list that his loss of bladder control is a pretty serious indicator, then, despite his limb movement?
Is this list the same regardless of case? I presume it is still possible for him to lose DPS at this point with further inflammation?
The first sign of trouble would be no tail wags
wags? I get this response most when we go outside
and he sniffs the grass, btw. How many potty times per day should I be allowing at this stage?
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 16, 2022 20:02:42 GMT -7
Mark, what is your dog's name?
To monitor neuro function, pretty much you would be looking for a head level involvement with any leg, tail, bladder function. -- sniffs (head level) and then releases urine -- hears (head level) happy talk from you, then a happy wriggle/wag Things that happen during potty time are very likely due to reflex movements. Such as tail or legs can move due to the reflexes associated with pooping and being expressed. No one wants a dog on prednisone one bit past the point of the benefit of all painful swelling gone. No one know how long resolution of swelling will take. It is different for every dog. All we know is it falls in the range 7-30 days to resolve swelling with an anti-inflammatory such as prednisone. This is why a vet has to make a guess of how long the pred course should be. Many vets guess at 5 or 7 days. THEN it is the pred taper that tells the story if all swelling is actually gone. Keeping pain meds on at the start of the taper puts a blind fold on YOUR eyes to quickly and accurately assess about pain. Being able to quickly get Pred back on board up at the anti-inflammatory level IF NEEDED, means it could reverse neuro diminishment. Hours matter VERY much when there is neuro decline getting meds on board. Pred taper days are no longer working on swelling if is exists but being hidden by pain meds. RULE OF THUMB on the Pred Taper pain = swelling = another course of anti-inflammatory pred
+ pain meds+ Pepcid AC
no pain = swelling gone! = finish out the pred taper. Finish the 8 weeks of STRICT rest to heal the disc.PLAN BWith any TAPER, it is always good to have worked out in advance a "PLAN B" should pain re-surface at night or on the weekend when your vet is not open. Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit is very expensive, a "Plan B" is free! POTTY TIME While on pred and increased thirst: -- if bladder control and staying dry, take out every 3-4 hours -- if lost bladder control, leaking when lifted, then express in the house every 2-3 hours as you are learning. Increase to 3-4 hrs, then 6-8 hrs as you become proficient. -- You need to know for sure if there is bladder control or not. It is a health reason to learn express if no bladder control. Bladder infections can happen quickly with no control These tips and more at this page: dodgerslist.com/2020/05/14/strict-rest-recovery-process/ Use a rear sling to support wobbly back legs in a stand position to poop. use a front sling also if need be. A sling is used as back up to catch a wobbly dog's butt and prevent twisting the back. Any sling needs to be accompanied by a front harness and leash to control speed to the very slow minimal footsteps at potty time especially during conservative treatment. You might need both a front sling and a rear sling. A figure 8 DIY sling works especially well for the male dog anatomy at potty times. 1) DIY sweatshirt sling...can be used for front or the back legs. Use same concept with cut out leg holes in a long strip of towel: www.lyonpuffpetsit.com/htmlslp/sling.html2) DIY figure-8 sling: dodgerslist.com/wp-content/uploads/2020/05/Figure8.jpg ** An ex-pen at potty time eliminates need for a harness to control speed. The fence gives a visual and physical there will be no sniff festing or darting off. A harness and 6 foot leash is to control speed and keep footsteps to minimum as you stand in one spot. |
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Post by Mark J on Apr 17, 2022 7:35:49 GMT -7
Lots of great information again - thanks! Unfortunately, Tyson's regular vet clinic is also an emergency hospital, so the doctors rotate. The doctor who assessed, diagnosed our case, prescribed the meds, made the referrals for surgery option, etc. has her next shift at midnight. I have a request that she call me then, but besides the prednisone question, this also makes the learning to express from the vet really difficult.
Perhaps it is time to seek a regular vet / non-clinic doctor / second opinion?
I gave ▲prednisone as usual with just 50 mg ▼Gabapentin this morning and will be able to speak to her only at the end of the day. I will ask about the Plan B meds which sounds to me like a great idea.
[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 11 y.o.
prednisone as of 4/12: 5mgs 2x/day for ▲6 days, then 4/18 test taper for: _pain / _neuro
gabapentin 50 mgs tab: ▼50mg 3x/day
methocarbamol 200mgs/1 mL: 120mg (0.6mL dose) 3x/day
Tyson needs GI tract protector, Pepcid AC, on board w/prednisone!]
He had another pee or [overflowed??] this morning right before I had a chance to take him outside (directly following breakfast meal.
Should I consider potty time first thing in the morning rather than meds / meal?). He whines when he pees, but I am not sure it is because he knows he is doing it and tries to warn me, or because he has already done it and feels wet / unhappy.
He has a favorite TV show that sends him over the edge -- just the music elicits growls and tail wags -- so I guess that music can serve as my deep pain monitor (sound + tail wag = head level)?
I ordered a Help 'Em Up Haress online based upon vet and physiotherapy clinic's recommendation -- I assume that will be appropriate to use for potty time right away?
My biggest question right now is how will I be able to know in time whether the pain caused by swelling returns during taper? What are the reliable signals of pain versus something else? (wanting food, to get out, to be on me, etc.).
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 17, 2022 10:16:59 GMT -7
Mark, if you need to speak with a vet, then any vet at the regular vet clinic/ER hospital has access to examination info in Tyson's file. That means the vet on duty can adjust meds, etc. You should be able to set up an appt with your regular vet who can also see Tyson's file made by the ER doctor. Then your regular vet may also be able to adjust meds, etc. As for getting a lesson expressing the bladder. The vet or his vet tech can often give you a hands over your hands type of expressing lesson. VOCABULARY peeing is an act caused by the brain. The brain tells the bladder to release urine in an appropriate spot. Often appropriate to mark over another's urine, etc. overflowing bladder is an act initiated by reflex. At the point the bladder if very full, reflex triggers urine release. No brain involved. Kinda like no brain involved when your hand quickly withdraws from a hot stove. It is reflex that moves your hand. First thing upon awakening or even setting an a.m. alarm a little earlier, take Tyson out for a few mins of potty time. Eating fills the tummy and presses on the bladder. Throughout the day, potty break every 3-4 hrs. If he can sniff and then release urine AND you find no urine leaks in bedding AND he is not leaking on you when lifted— he has bladder control and is "peeing." If you are not taking him out on time and he just has to go, then he has bladder control and due to great discomfort from a full bladder he had to "pee" where he sleeps— he had no choice but to do it. If he leaks on you when lifted AND EVEN IF you are taking him out for a potty break every 3-4 hrs you are finding urine leaks in bedding investigate these things: --- Caths are known to invite possible bladder infection if things have not been fully sterile. --- he may already have developed a urinary tract bladder infection (UTI). UTI's can happen quickly in a matter of days when a dog whose bladder is "overflowing" due to reflex. A urinalysis test on a sample of urine is run in the clinic/hospital while you wait. This test can determine if there is infection. An antibiotic is what will kill the bacteria. The concern is to treat in a timely manner w/antibiotic that infection does not move up into the kidneys. --- he may not have full return of bladder control yet. You'd need to do a quick express check AFTER Tyson has "peed" all he can. Express check until you are satisfied he can fully void on his own. Let us know what you observe and figure out with some detective work if Tyson is "peeing" or has no bladder control and is "overflowing" Overflow requires a hands-over-your hands expressing lesson Monday morning, maybe a urinalysis too. Help Em UP harness (for the back end?) would be good. If you need a font end sling you can make that yourself or the company has one for sale. -- HELP 'EM UP: A complete shoulder and hip harness system: helpemup.com/features/sizes for 10 to 225 pounds dogs. The Help 'Em Up Harness "is the best solution we’ve found to date. It quite literally lets you quickly and easily pick your dog up like a large piece of luggage that has a shoulder strap. The shoulder strap is sold separately but I highly recommend getting it along with the full harness. As hard as it was for two of us to move our dog before, now that we have this harness and the shoulder strap, I know I can move her by myself if I have to." by Rebecca Minick at thespeckleddoor.com/transporting-a-large-dog-who-cant-walk/SIGNS OF PAIN to monitor during the pred taper: ⚙︎ shivering-trembling ⚙︎ yelping when picked up or moved ⚙︎ tight tense tummy ⚙︎ arched back, ears pinned bac ⚙︎ restless, can't find a comfortable position ⚙︎ slow or reluctant to move in suite such as shift positions ⚙︎ not their normal perky interested in life selves ➕if a neck disc: ◻︎ head held high/ nose to the ground ◻︎ looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to painful chewing or in too much overall pain ◻︎ holds front or back leg up flamingo style not wanting to bear weight |
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Post by Mark J on Apr 17, 2022 10:59:08 GMT -7
[This post is being marked for clues. If there is a correction or additional info, provide in a new post. Thanks]
I am worried that yesterday and today his spirit and energy are seriously depleted -- he seems exhausted and immobile but isn't actually sleeping [pain?]. He is usually watching me always but now seem uninterested and even faces away from me. Is this a sign of pain or even something worse? He improved a little at bedtime last night but turned a lot during the night [pain?]. Is it ususal for a dog to become lethargic / detached / immobile during first week of crate rest phase? Depression?
[posted 4/16: "Prednisone 5 mg tabs - 1 tab / 12 hours"]
I gave:
prednisone [4/17] this morning ▲7mg[?] at 7 am as usual -- this is his last day before taper begins [4/18] after his 7 pm dose tonight.
▼Gabapentin gave 75 mg, and
▼Methocarbomol 0.6 ml. at 7 am. Will give same at pm and 11 pm. [clarify how many times a day exactly given?]
[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 11 y.o.
prednisone as of 4/12: ▲7mgs 2x/day for 6 days, then 4/18 test taper for: _pain / _neuro
gabapentin 50mgs tab: 50mg 75mg ▼2x/day
methocarbamol 200mgs/1 mL: 120mg (0.6mL dose) ▼2x/day
✙Pepcid AC 5mgs 2x/day as of Sun 4/17?]
I will try for potty first thing -- I fear he may be wetting due to overwaiting for me. He has not overflowed when picked up or during the night in his bedding.
Still reluctant to drink water when I offer -- putting 1/4 cup [h20] in his food 2x / day to ensure some intake, but odd he takes only a few laps of water when offered, if at all.
Had a poop at potty time (your home-made fabric igure-8 sling worked well -- thanks!).
Posted 2 hrs later:
Disposition at dinner much improved. Must have just needed rest! Adding more water to food to compensate for water refusal, and am now adding 5 mg. ✙Pepcid AC before each dose of Prednisone.
Tried sniff test a few times today with no success and afterward expression, also no succcess but being very gentle. I feel like I have maybe located the plum-sized sack, but mild pressure produces nothing but a whine. Will try again as we both get more comfortable with the sensation. Hope you are having a happy Easter, and thanks again for all the advice / support.
Also -- and I am not sure you can answer these questions --
but I am essentially taking a conservative path to potential surgery, working on the premise that, after seeing whether Tyson's body can heal itself with some help from drugs for a few weeks, I can re-assess and still opt for surgery if it seems warranted. Does that seem like a sound course to follow, or is there a risk that it may be too late?
Some literature mentions time from injury to surgery being of the essence, while other readings suggest that as long as deep pain is still present, surgery remains an option. Is there a time limit to when surgery can help if deep pain is not interrupted, or will scar tissue make surgery more complicated / difficult / unsuccessful? If you know where I can find any answers to those questions, I would be very grateful!
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Post by Mark J on Apr 17, 2022 15:03:11 GMT -7
Paula! Just had an Easter miracle. Took Tyson out for his potty using the figure 8 sling and he sniffed the grass and peed! Thank you so much for the support. I am over the moon!
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PaulaM
Moderator.
Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 17, 2022 15:28:34 GMT -7
Mark, see if this is now the current med list for Tyson. The best way to report meds is with details of name, mgs/mL dose and how many times/day. The date if any change is made in order to observe correlations w/pain, GI or neuro issues. prednisone as of 4/12: 5mgs 2x/day for 6 days, then 4/18 test taper for: _pain / _neuro gabapentin 50mgs tab: 75mg ▼ 2x/daymethocarbamol 200mgs/1 mL: 120mg ( 0.6mL dose) ▼ 2x/day✙ Pepcid AC 5mgs 2x/day as of Sun 4/17?
If you are adding 1/2 cup of water that might be enough IF the food is canned or other high hydrated food. What type of food do you feed?Was the poop constipated or normal OR loose? (See how we LOVE the detail? We want to know what your eyes see.) It may well be he does have bladder control since you are not finding leaks in bedding IF you get him out to potty at reasonable intervals (maybe every 3-4 hours while on pred.) Dogs who do have bladder control will not like you pressing on their bladder as they want to do the controlling release of urine, not you doing it. TWO TREATMENTS: Spinal cord injury caused by the disc episode can involve both compressing of the cord and cord bruising. Surgery only treats the compression problem by removing the offending disc material. Part of the healing that goes on in conservative treatment is the body's natural response to cord bruising. In addition an anti-inflammatory drug is also used to reduce compression from swollen tissues in the spinal cord area. Often with time the disc material may also be able to be reabsorbed enough to no longer press on the cord and aggravate it. When deep pain sensation (DPS) has been lost, surgeons want to operate within a window of hours of that loss. DPS is the marker neuro function that means the body very likely can self repair nerves. Tyson has DPS and more since he can move his legs and may have bladder control. Those neuro functions bode well for more nerve healing to take place. Best to think in term of months rather than days/weeks for the slowest part of the body to heal—nerves. MEDs: There are no meds nor treatments to heal nerves. The body has the ability to self heal nerves with time whether with a surgery or under conservative treatment. Meds are used to provide comfort from pain, protect the GI tract, and help the body reduce painful inflammation. As long as there is no NEW or increased neuro diminishment, his body is going forward with nerve healing, it just takes time. At this point, it really seems as though Tyson is going on a good direction of healing under conservative treatment. Prednisone is getting the swelling down that damage nerves. The taper test tomorrow 4/18 will provide info if swelling is actually now gone or are the pain meds currently blocking your vision about pain. If pain, then another course of pred is needed. April 12: minor rear leg mobility, no front leg ability Nerves heal typically in the reverse order of the damage to the spinal cord. Tyson is, indeed, showing signs of nerve healing! 1. YES Deep Pain Sensation: the first neuro function to return. DPS is the critical indicator for nerves to be able to self heal after surgery or with conservative treatment. Trust only the word of a neuro (ACVIM) or ortho (ACVS) surgeon about this very tricky to correctly idenfiy neuro function. 2. YES Tail wagging with joy at seeing you or getting a treat or meal. 3. 4/17 Bladder and bowel control verified with the "sniff and pee" test. 4. 4/13 back _4/14 front leg Movement,and then 4/14 back _ front legs ability to move up into a stand position, ___ back _____ front legs wobbly walking. 5. Being able to walk with more steadiness and properly place the paw. 6. Ability to walk unassisted and perhaps even run. LEARN MORE: dodgerslist.com/2021/02/06/nerve-healing-after-disc-episode/Please do explore further — all of the comparisons to help your mind sort out and arrange all this information. Then you will have the background to discuss, ask good questions and sort out a surgery or conservative treatment approach. Good to have that kind of information under your belt. IVDD is a disease that some dogs have only one disc episode their entire life. While others can have multiple disc episodes. dodgerslist.com/2020/02/10/surgery-vs-conservative/ i.postimg.cc/26dgyWcP/Cons-vs-surgert-chunk.jpg ** |
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Post by Mark J on Apr 17, 2022 16:52:32 GMT -7
3. YES 4/17 Bladder and bowel control verified with the "sniff and pee" test .
4. 4/13 back 4/14 front leg Movement, and then
4/14 back not yet front legs ability to move up into a stand position,
___ back _____ front legs wobbly walking.
There is so far no "walking" per se, but strength is returning in all 4 limbs
-- back more than
-- front, which is still weak, knuckling, and rigid.
-- He is able to rest paws under him while lying down, and
-- reverse his position (180 degree turn), however.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Apr 17, 2022 17:18:38 GMT -7
Mark, good to have bladder control confirmed.
Looks like with your adherence to STRICT rest, his disc will be healing by graduation day on June 7! Conservative focuses on getting the disc to heal. Nerve function may or may not come back in that short of time.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Apr 17, 2022 17:20:59 GMT -7
Is this the current med list?
prednisone as of 4/12: 5mgs 2x/day for 6 days; 4/18 test taper for: _pain / _neuro
gabapentin 50mgs tab: 75mg ▼2x/day
methocarbamol 200mgs/1 mL: 120mg (0.6mL dose) ▼2x/day
✙Pepcid AC 5mgs 2x/day as of Sun 4/17?
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Post by Mark J on Apr 17, 2022 21:02:05 GMT -7
I have been adminisering so far:
Gabapentin [?mgs] 3x per day (8 hours) - still waiting to hear from vet re: taper
Prednisone [?]mgs 2x/day for 5 days (episode day took one dose) - still waiting to hear from vet re: taper
Methocarbamol 200 mgs/ml: 120mg (0.6ml dose) 3x/day (every 8 hours) for 7 days
Pepcid AC 5 mgs [2x/day] 30 minutes before prednisone dose (see above) [DATE STARTED?]
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Post by Mark J on Apr 18, 2022 11:00:09 GMT -7
[Mon Apr 18]Just returned from visit to vet with new prescription, for your review and comments / recommendations. I expressed concern re: Prednisone taper, and vet agreed to double to course (and create a "Plan B" for another course if necessary once revised wean begins (five days from now). She also brought another pain killer on board (Tramadol), but I am not completely sure it is necessary. She advised using it whenever the prescibed dosage of Gabapentin seems insufficient. Daily meds are currently as follows:
Pepcid AC - 5mg / 2x daily, 30 minutes before Prednisone dosing
Prednisone - 5mg / 12 hours for 5 (more) days (taper thereafter)
Gabapentin - 75mg / 8-12 hours
✙Tramadol - 25mg / 8 hours (as necessary)
Methocarbamol - 200 mg/ml - .06 ml / 8 hours
[MED LIST/HISTORY- Moderator's Note. Please do not edit
15 lbs 11 y.o.
prednisone as of 4/12: 5mgs 2x/day for 6 days
as of date 4/18: 5mgs 2x/day for 5 days, 4/23 test taper for: _pain / _neuro
gabapentin 50mgs tab: 75mg 3x/day
✙traMADol 25mgs 3x/day
methocarbamol 200mgs/1 mL: 120mg (0.6mL dose) 3x/day
Pepcid AC 5mgs 2x/day ]
We are now getting snow which makes me worry about our next sniff and pee (and also sorry for all the fur babies and folks who have to go through all this in the dead of winter), but I suppose I can just clear his spot for him if he has trouble finding it. He has never liked doing his business in the snow (and I can't say I blame him).
p.s. Morning poop already looks better with no dark streaks -- hooray, Pepcid AC!~
Am currently giving Gabapentin - 75mg / 8 hours, but script is flexible
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 18, 2022 12:11:51 GMT -7
Mark, thanks for the med details. Details help us to follow along and make accurate comment.
PAiN
During the disc episode the vet makes their guess as to how long the course of pred will be. Today your vet guessed a 5-day course might resolve all swelling. Again it is the start of Sat 4/23 taper that gives the proof.
In the meantime, please understand about pain and keeping it in control and why pain meds are NOT given as needed and the need to address each of the 3 sources of pain. Pain meds last effectively in the body for about 8 hrs.
traMADol as the over all analgesic maybe such as with the disruption of the normal articulating anatomy of a joint. The joints between the vertebrae are called facet joints.
gabapentin for nerve pain
methocarbamol for muscle contraction pain.
Everything can just hurt more, pain is heighten when experienced under conditions of stress or anxiety. Our dogs are stressed with the physical pain of a disc episode. All of their routines have been changed with crate rest..that is a stressful thing. So knowing a disc episode is a painful thing, it is prudent to act like it is painful and use an aggressive pain med approach.
During a disc episode which is known to be a painful thing, it is best to act like it by being aggressive with pain meds. Not waiting til you see if there is pain surfacing. Not fair to the dog. At the end of the pred course, THEN, it is time to observe and make assessments about the existence of pain. Taper the pred for health reasons, stop the pain meds so they no longer blindfold you about truth of any hint of pain existing.
Currently now, with all 3 pain meds on board, should you observe any hint of pain, then alert the vet of your observations. Look for traMADol to be Rx'd more at the max analgesic dose for a 15lbs/6.8kg dog: traMADol 50 mgs 3x/day.
READING REFERENCE:
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Post by Mark J on Apr 18, 2022 15:04:39 GMT -7
In your experience, what is typically an appropriate course for an anti-inflammatory dose of prednisone in response to a Level 4 IVDD cervical episode?
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
Posts: 19,928
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Post by PaulaM on Apr 18, 2022 16:08:39 GMT -7
I've had three dogs who have had disc episode. The only typical observations I have had since being on this Forum from 2007 and watching over 10,000+ dogs who had disc episodes and what their vet's prescribed, is it takes somewhere in the range of 7 days to 30 days before an anti-inflammatory drug is able to rid the body of painful inflamed tissue surrounding the spinal cord.
Since no one, not even vets, can know exactly how long any anti-inflammatory drug will take, they often take a guess at a 5-day or 7-day course of pred. All anti-inflammatory drugs have side effects. This warrants not keeping a dog past the point of benefit where all inflamed tissue is back to normal.
Nerves become damaged by pressure. The spinal cord canal is rather narrow. A disc invading the canal area can put pressure on the nerve bundle. Inflamed swollen tissue around the cord can squeeze. There are no meds, no surgical procedure that heals once the nerve function has been lost. Only the dog's body will tell that healing time story.
Patience with nerve healing is needed. That is not something us humans are used to when so many things in society today are fast/quick.
Now that traMADol 25mgs 3x/day has been in his system for at least an hour, what do you observe about: reluctance to move much, normal repositioning his body in the suite time to time, can't find a comfortable position, interest in what's going on in his home ?
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Post by Mark J on Apr 18, 2022 16:26:46 GMT -7
Is there a risk associated with remaining on Prednisone for a full 30 days to ensure all inflammation is gone? I hate the thought of risking further damage by tapering too soon. Also wondering (since nobody seems to give a straight answer) whether there is any risk in initially following a conservative course after IVDD to monitor response? Is there a point at which surgery is no longer an option as long as DP remains, or does chance for success decrease after a specific time even when deep pain remains? Sorry to ask so many questions but you are so erudite on the subject.
I will report more on any changes tomorrow -- tonight may not be a good indicator since he got a little upset about resorting to peeing and pooing in his suite today. We had potty time before dinner but it was cold, wet, snowy and miserable and he was shivering a lot and very tentative, so we cut it a little short. We came inside and I fed him dinner, after which I SHOULD have taken him staight back out, but I cleaned up briefly and by the time I returned, the deed was done. He gets quite upset when he voids indoors, so his subdued mood tonight may be a reflection of that. I still notice some head adjusting in his bed but not as much as previously. Generally, he is still quite low key. My sense is that his neck / shoulder area is still in some pain, but I will reassess tomorrow.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Apr 18, 2022 18:15:39 GMT -7
MORE IS NOT ALWAYS BETTER Mark, all anti-inflammatories affect many organs of the body. That is why NO ONE wants a dog on any anti-inflammatory (steroid or non-steroid NSAID) if it has already done its job. NO ONE wants a dog on pred for 30 days without finding out via the taper if there is an actual pred job left to do. The hormone prednisone is a miracle worker when there is a job for it. My personal opinion, it is malpractice to prescribe this drug when the body has nothing for it to work on. Here's 3 prednisone issues in a long list of 42 from the veterinary bible on drugs Plumb, DC. Veterinary Drug Handbook, PharmaVet Publishing, White Bear Lake, Minnesota. 1991 1. (prednisone induced) Cushing's disease. 2. shortens clotting time, risk of GI ulcers (hence use of Pepcid AC) 3. susceptibility to secondary infection such as bladder infection My go to for reading about my dog's meds (Mar Vista Animal Medical Directory marvistavet.com/libraries.pml ) Here's prednisone marvistavet.com/prednisone.pmlThe pred taper and assessment happens quickly. You have a Plan B should pain or neuro diminish develop. You can get Prednisone back up at the anti-inflammatory dose asap that night. As mentioned prednisone is a miracle drug. I have seen with my own eyes. My dog started to knuckle under his paws. Vet appt at 9am. I got the Rx filled and back home by 11am to dose. Within the hour his paws could right themselves correctly! Hours matter in getting the right meds on board to catch nerve damage before it becomes too much. You are prepared, you have a Plan B. Generally speaking — not sure there is any surgeon who would want to take on the risks a surgery can have. All of life is the weighing of risk vs. benefit. A surgeon would prefer to try the least invasive conservative (medical) treatment first. Dr. Isaacs, Neurology (ACVIM) Check out this excellent interview with him where he has answered so many of the questions the IVDD community wants to know about: dodgerslist.com/2020/05/12/dr-isaacs-surgery-answersMark, take things one step at a time instead of jumping the gun on thinking about surgery. Right now Tyson is going in a good direction of healing. Conservative treatment is working. Until you see that conservative treatment is not getting the disc to heal, or that the meds are not getting painful swelling taken care of, then it would be time to get a consult with a neuro. Mark, read the rest of this article: dodgerslist.com/2020/02/10/surgery-vs-conservative |
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Post by Mark J on Apr 19, 2022 7:26:06 GMT -7
Happy to report sniff and pee success again this morning with some persistence. Snow and wet and cold do not make for a very inviting potty environment! Had to tough it out a full 15 minutes.
Thanks for the link to the information re: prednisone -- very helpful. Thanks also for the link to the interview with Dr. Isaacs! I had read through it several days back, but when I tried to find it again, I couldn't. It provides some great answers to my concerns about whether surgery might still be an option if the conservative course fails. I do have some lingering questions / concerns:
When Dr. Isaacs says, "The dose and course of steroids vary depending on the response. Some dogs respond well, and I am able to taper completely off of the steroids. The goal is to find the lowest effective dose required to help with the neurological status," what constitutes "responding well," what should the dog's neurological status be exactly, prior to tapering. Should conscious proprioception return prior to the taper, or will this return later? Tyson is still knuckling on all four feet at present. Or does he mean that once bladder control returns, the steroid has done its job and it is time to begin tapering? I suppose I am confused about which symptoms can be attributed to spinal cord compression, which anti-inflammatories can relieve, and how much can be attributed to spinal cord bruising, which only time can heal. I worry whether the low-key character exhibited for the past few days might be the result of the prednisone rather than a response to swelling -- how can I tell the difference? And how do I differentiate pain symptoms from neurological or swelling symptoms? I don't want to do any of this wrong, and I don't feel qualified or experienced enough to feel confident with such a vital task. What I could really use is a step-by-step guide to steroid tapering and reading the signs. Does anything of that sort exist? And does the steroid continue to provide ANY anti-inflammatory benefits during the taper? Will the Prednisone taper produce only negative symptoms or are there positive signs to watch for as well.
Also wondering about your take on cold compresses and tickling, which I read early on the Marvista site but nowhere else.
"Ice packing applied for 10-15 minutes (with a cloth separating the ice pack from the dog) is also helpful in relieving inflammation. During the first 3-5 days of an acute episode, icing can be performed as many times daily as possible ultimately tapering to three times daily for the duration of the confinement (or for as long as there is pain)." Have you practiced ice packing for inflammation? It seemed to provide some cervical relief for Tyson when I did it -- should I resume it again? My Gabapentin supply lasts only another week or so -- how long will I be needing to dose at this level? How much supply should I have in stock? My emergency hospital vet is frequently away for days at a time, which makes me concerned. Would you advise my seeking out another vet at this stage, or is it better to have all the records in one place?
My most immediate concern is that for the past few days, I am seeing a differnt dog -- far more low-key and uninterested / immobile. During potty time, I see a DECREASE in desire / ability / willingness to explore or take interest, and that lethargy also translates to his investment in me and activity in the home. Is this a sign of decreasing function (I am assuming that's unlikely given that he's still passing "sniff and pee"?) or could the prednisone be the culprit here?
With the tramadol now on board, could it still be pain, or is it unlikely to see the pain spike so much after the first several days. I am really getting worried. He perks up a little at night, but practically unresponsive unless it is a meal.
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PaulaM
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Member since 2007: surgery, conservative . Montana, USA
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Post by PaulaM on Apr 19, 2022 10:01:52 GMT -7
Mark need the context of Dr. Isaacs quotes you gave (a link to the article). So my comments are of a general nature. ROADMAP I think if you have the ROADMAP on your fridge you can refer to each of the 4 phases of healing. The map is a visual and organizational tool to let you know what things it takes to heal a particular phase. How long it takes to heal that phase. Please tape it to your refrigerator. Any time your mind wonders something check the ROADMAP. D/L and print from this link: dodgerslist.com/wp-content/uploads/2020/07/Roadmap-for-Fridge.pdfneurological "responding well"
No new or increasing diminishment of neuro functions. Scroll up to my Apr 16, 2022 at 7:16pm post for the predictable order of neuro diminishment to watch out for on a taper " HOW to monitor neuro function" Prior to the start of a taper, the neuro function a dog has is what it is. The state of neuro function is not mended by pred (the body self heals nerves in months). The pred taper is to proove/reveal if existing pain/swelling. Here's an analogy: waiting for a pot of water to come to a simmer. With the lid (pain meds) on you don't have proof of simmer bubbles. Take the lid off (taper pred and no pain meds) and you can observe if there are simmer bubbles (pain or new/increased nerve diminishment). No one can give you a date/time table for when Tyson's body will heal/repair nerve damage. Prednisone's ONLY job is to resolve inflammation. Prednisone does not mend nerve damage such as knuckling, bladder control, etc. Only Tyson's body over the course of maybe months will self heal nerve damage. There are no medications that heal nerve damage. Brusing vs compression. These conditions of spinal cord damage can be seen by the surgeon during the procedure. differentiate pain symptoms from neurological or swelling symptoms?
Scroll back up to see the full list of pain signs the predictable neuro signs. Have you incorporated one of the tips recommended— a med chart? It helps you to note events and correlate changes in meds to see patterns....the same patterns we seek via your detailed info on meds and observations. A medication chart is useful place to have dates and specific facts handy as you discuss things with the vet. D/l a sample and a blank form to use with your dog's meds dodgerslist.com/wp-content/uploads/2020/02/med-chart-printable.pdfIf the pain meds are correctly Rx'd then no compress is needed. In general do not touch, massage your dog. Tickling paws is a no-no during limited movement demanded of conservative treatment. When off of all meds and legs are still weak, we have information on the safe way to do thing while the disc is still healing.
SIGNS OF PAIN: ⚙︎ shivering-trembling ⚙︎ yelping when picked up or moved ⚙︎ tight tense tummy ⚙︎ arched back, ears pinned bac ⚙︎ restless, can't find a comfortable position ⚙︎ slow or reluctant to move in suite such as shift positions ⚙︎ not their normal perky interested in life selves, far more low-key and uninterested, decrease in exploring ➕if a neck disc: ◻︎ head held high/ nose to the ground ◻︎ looks up with just eyes and does not move head and neck easily. ◻︎ not eating due to painful chewing or in too much overall pain ◻︎ holds front or back leg up flamingo style not wanting to bear weight
Have you reported continue signs of pain TODAY to the vet? As mentioned in last previous post yesterday a READING REFERENCE about traMADol. Basically for a 15lbs dog Tramadol 25mgs 3x/day is like not giving any traMADol! Advocate for Tyson. EXPECT when you report still pain, your vet moves to the MAX analgesic dose more like: traMADol 50mgs 3x/day.
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Post by Mark J on Apr 19, 2022 17:12:26 GMT -7
Like a different dog tonight. He has suddenly become animated and almost frisky again. Not sure whether the Tramadol finally "kicked in" or what, but it is such a great sight to see him "smiling" at me again and not constantly and morosely adjusting his head/neck position. Passed sniff and pee again tonight with some reluctance initially. Will continue to monitor and report again tomorrow. Hopefully this little rascal is starting to feel more like himself.
If I am reading correctly, it seems like urinary function will be the thing for me to watch closely during the prednisone taper, considering the current state of Tyson's neuro function, then.
Thanks for that analogy and for the practical example of your dog's knuckling correcting quickly with the administering of prednizone. I wonder about how quickly a lack of the drug makes a neuro impact. Once I taper (and do you have any advice re: time of day to administer once we taper to 1x/day?), how soon will I be able to see the signs of inflammation (i.e., urinary function / bladder control)? Taper begins 4/23.
Not to overwhem you with questions -- you've already been so generous! -- but I also would appreciate knowing your opinion on physiotherapy. The potential therapist to whom I've been referred wants to book a consultation on 11 May (and says she needs $100 deposit now), but is that too early? I have seen a few online therapists who send you the recorded sessions after irtual consultation, which seems great since it doesn't involve disturbing crate rest. What are your thoughts on this topic?
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